HMBPP/多肽E7对结核患者胸水及脐带血中γδ T细胞分泌IL-6的影响

doi:10.3877/cma.j.issn.1674-0785.2020.08.002

中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (08) : 592 -598. doi: 10.3877/cma.j.issn.1674-0785.2020.08.002

所属专题：文献；

临床研究

HMBPP/多肽E7对结核患者胸水及脐带血中γδ T细胞分泌IL-6的影响

常铸¹, 梅志雄², 方毅敏³, 王姣¹, 黄明柳¹, 赖小敏¹^,^†(

)

^1. 510080　广州，中山大学中山医学院微生物学教研室，热带病防治研究教育部重点实验室，结核病研究所，海洋微生物功能分子广东省高校重点实验室，广东省重大传染病预防和控制技术中心
^2. 510530　广州，中山大学第三附属医院岭南院区妇产科
^3. 510095　广州，广州市胸科医院，国家呼吸疾病重点实验室

收稿日期:2020-03-24 出版日期:2020-08-15
通信作者: 赖小敏
基金资助:
国家自然科学基金面上项目(81271779); 十三五传染病重大专项分任务(2018ZX10715004-002-003)

Effect of HMBPP and peptide E7 on IL-6 production by γδ T cells in pleural fluid of tuberculosis patients and umbilical cord blood

Zhu Chang¹, Zhixiong Mei², Yimin Fang³, Jiao Wang¹, Mingliu Huang¹, Xiaomin Lai¹^,^†()

^1. Department of Microbiology, Zhongshan School of Medicine, Key Laboratory of Tropical Disease Control, Institute for Tuberculosis Control, Sun Yat-sen University, Guangzhou 510080, China
^2. Lingnan Hospital, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510530, China
^3. Guangzhou Chest Hospital, State Key Laboratory of Respiratory Disease, Guangzhou 510095, China

Received:2020-03-24 Published:2020-08-15
Corresponding author: Xiaomin Lai
About author:
Corresponding author: Lai Xiaomin, Email: laixm@mail.sysu.edu.cn

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引用本文：

常铸, 梅志雄, 方毅敏, 王姣, 黄明柳, 赖小敏. HMBPP/多肽E7对结核患者胸水及脐带血中γδ T细胞分泌IL-6的影响[J/OL]. 中华临床医师杂志(电子版), 2020, 14(08): 592-598.

Zhu Chang, Zhixiong Mei, Yimin Fang, Jiao Wang, Mingliu Huang, Xiaomin Lai. Effect of HMBPP and peptide E7 on IL-6 production by γδ T cells in pleural fluid of tuberculosis patients and umbilical cord blood[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(08): 592-598.

目的

研究4-羟基-3-甲基-2-烯基焦磷酸（HMBPP）和多肽E7对结核患者胸水及脐带血中γδ T细胞分泌白介素6（IL-6）的影响和机制。

方法

收集自广州市胸科医院临床诊断结核性胸膜炎患者胸水标本18例，自中山大学附属第三医院正常健康产妇脐带血标本17例。使用流式分选技术分选出结核性胸水和脐带血中的γδ T细胞与CD277^＋CD14^＋单核-巨噬细胞混合培养，分别用HMBPP或E7刺激后，运用流式细胞术检测分泌IL-6的γδ T细胞百分率及表达程序性死亡配体1（PD-L1）的CD277^＋CD14^＋单核-巨噬细胞百分率；利用RT-PCR技术检测细胞中IL-6、PD-L1的mRNA表达水平；用ELISA方法检测细胞培养上清中IL-6的含量；用PD-L1特异性小分子干扰RNA（siRNA）沉默PD-L1的表达以检测PD-L1是否参与分泌IL-6；在分选于结核性胸水和脐带血的共培养细胞中，HMBPP或E7刺激后上述指标在每一时间点对照组和实验组间分别采用独立样本t检验比较其差异，分析其统计学意义。

结果

在结核性胸水和脐带血中，给予HMBPP或E7刺激24 h之后，与对照组相比IL-6^＋γδ^＋ T细胞占比显著升高，给予HMBPP或E7刺激12 h之后γδ T细胞中IL-6在mRNA水平的相对表达量显著上调，以及在蛋白质水平的表达显著上调；在分选于脐带血的共培养细胞中，给予HMBPP或E7刺激，CD277^＋CD14^＋单核-巨噬细胞中PD-L1在mRNA水平的相对表达量显著上调［（3.70±0.33）vs（4.20±0.34）vs 1.00］；在沉默PD-L1的表达后，γδ T细胞中IL-6的表达显著降低［（0.53±0.03）vs（0.55±0.01） vs 1.00］，差异均具有统计学意义（P均<0.05）。

结论

HMBPP和多肽E7能够促进CD277^＋CD14^＋单核-巨噬细胞PD-L1表达上调，后者参与刺激与其共培养的γδ T细胞分泌更多的IL-6，这为γδ T细胞的抗结核免疫机制的研究以及结核患者的免疫治疗提供依据。

关键词: γδ T细胞, CD277^＋CD14^＋单核-巨噬细胞, 白介素-6, 程序性死亡配体1

Objective

To investigate the effect of (E)-4-hydroxy-3-methyl-but-2-enyl diphosphate (HMBPP) and peptide E7 on the production of interleukin-6 (IL-6) by γδ T cells in the pleural fluid of tuberculosis patients and umbilical cord blood.

Methods

Eighteen samples of pleural fluid were collected from patients who were clinically diagnosed with tuberculous pleurisy at Guangzhou Chest Hospital and 17 samples of umbilical cord blood were collected at the Third Affiliated Hospital of Sun Yat-sen University. γδ T cells and CD277⁺ CD14⁺ monocyte-macrophages were sorted from the pleural fluid and umbilical cord blood samples by fluorescence-activated cell sorting. They were co-cultured and stimulated with HMBPP or E7. The percentages of γδ T cells secreting IL-6 and CD277⁺ CD14⁺ monocyte-macrophages expressing programmed cell death ligand-1 (PD-L1) were detected by flow cytometry. Expression of IL-6 and PD-L1 mRNA in cells was detected by RT-PCR. Secretion of IL-6 was measured by ELISA. PD-L1 specific small interfering RNA (siRNA) was used to knock down the expression of PD-L1 to detect whether PD-L1 is involved in the production of IL-6. After stimulation with HMBPP or E7, the difference in the above mean values was compared between the control group and the treatment group by independent sample t-test.

Results

In the pleural fluid of the tuberculosis patients and umbilical cord blood, after 24 hours of stimulation with HMBPP or E7, the percentages of IL-6⁺ γδ T cells were significantly higher than that of the control group. After 12 hours of stimulation with HMBPP or E7, the relative expression of IL-6 in γδ T cells was significantly increased at the mRNA and protein levels. After HMBPP or E7 stimulation, the relative expression of PD-L1 in CD277⁺ CD14⁺ monocyte-macrophages were significantly up-regulated [(3.70±0.33) and (4.20±0.34) vs 1.00]. When the expression of PD-L1 was knocked down, the expression of IL-6 in γδ T cells was significantly decreased [(0.53±0.03) and (0.55±0.01) vs 1.00]. All the above differences were statistically significant (all P<0.05).

Conclusion

HMBPP and peptide E7 up-regulate PD-L1 expression in CD277⁺ CD14⁺ mononuclear-macrophages, which are involved in stimulating co-cultured γδ T cells to produce more IL-6. This finding provides a basis for the research of the anti-tuberculosis immune mechanism of γδ T cells and the immunotherapy of tuberculosis patients.

Key words: γδ T cells, CD14⁺ CD277⁺ monocyte-macrophages, Interleukin-6, Programmed cell death ligand-1

表1 实时荧光定量聚合酶链式反应引物序列

基因名称	引物序列
IL-6	上游引物	5′-AAAGAGGCACTGGCAGAAAA-3′
IL-6	下游引物	5′-AGCTCTGGCTTGTTCCTCAC-3′
PD-L1	上游引物	5′-GGACAAGCAGTGACCATCAAG-3′
PD-L1	下游引物	5′- CCCAGAATTACCAAGTGAGTCCT-3′
ACTB	上游引物	5′-TGAAGGTAGTTTCGTGGATGC-3′
ACTB	下游引物	5′-TCCCTGGAGAAGAGCTACGA-3′

表1 实时荧光定量聚合酶链式反应引物序列

基因名称	引物序列
IL-6	上游引物	5′-AAAGAGGCACTGGCAGAAAA-3′
IL-6	下游引物	5′-AGCTCTGGCTTGTTCCTCAC-3′
PD-L1	上游引物	5′-GGACAAGCAGTGACCATCAAG-3′
PD-L1	下游引物	5′- CCCAGAATTACCAAGTGAGTCCT-3′
ACTB	上游引物	5′-TGAAGGTAGTTTCGTGGATGC-3′
ACTB	下游引物	5′-TCCCTGGAGAAGAGCTACGA-3′

表2 siRNA序列

名称	序列
siPD-L1	正义链	5′-CCACCAAUUCCAAGAGAGATT-3′
siPD-L1	反义链	5′-UCUCUCUUGGAAUUGGUGGTT-3′
NC	正义链	5′-UUCUCCGAACGUGUCACGUTT-3′
NC	反义链	5′-ACGUGACACGUUCGGAGAATT-3′

表2 siRNA序列

名称	序列
siPD-L1	正义链	5′-CCACCAAUUCCAAGAGAGATT-3′
siPD-L1	反义链	5′-UCUCUCUUGGAAUUGGUGGTT-3′
NC	正义链	5′-UUCUCCGAACGUGUCACGUTT-3′
NC	反义链	5′-ACGUGACACGUUCGGAGAATT-3′

表3 HMBPP或E7对结核性胸水分选出的共培养细胞中IL-6^＋γδ^＋ T细胞比例的影响比较（%，±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	6	2.38±0.36	3.35±0.23	3.80±0.26	5.02±0.35	5.17±0.36	5.82±0.35	7.41±0.49
HMBPP	6	3.36±0.37	3.87±0.25	4.88±0.45	7.67±0.50	9.29±0.55	19.94±0.85	23.76±0.90
E7	6	2.82±0.15	4.31±0.39	4.84±0.50	7.73±0.39	8.35±0.49	21.60±1.57	26.03±1.27
t值^a	?	1.89	1.53	2.05	4.34	6.31	15.44	14.75
P值^a	?	0.0877	0.1568	0.0676	0.0015	<0.0001	<0.0001	<0.0001
t值^b	?	1.11	2.12	1.80	5.21	5.26	9.80	13.69
P值^b	?	0.2915	0.0597	0.1019	0.0004	<0.0001	<0.0001	<0.0001

表3 HMBPP或E7对结核性胸水分选出的共培养细胞中IL-6^＋γδ^＋ T细胞比例的影响比较（%，±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	6	2.38±0.36	3.35±0.23	3.80±0.26	5.02±0.35	5.17±0.36	5.82±0.35	7.41±0.49
HMBPP	6	3.36±0.37	3.87±0.25	4.88±0.45	7.67±0.50	9.29±0.55	19.94±0.85	23.76±0.90
E7	6	2.82±0.15	4.31±0.39	4.84±0.50	7.73±0.39	8.35±0.49	21.60±1.57	26.03±1.27
t值^a	?	1.89	1.53	2.05	4.34	6.31	15.44	14.75
P值^a	?	0.0877	0.1568	0.0676	0.0015	<0.0001	<0.0001	<0.0001
t值^b	?	1.11	2.12	1.80	5.21	5.26	9.80	13.69
P值^b	?	0.2915	0.0597	0.1019	0.0004	<0.0001	<0.0001	<0.0001

表4 HMBPP或E7对脐带血分选出的共培养细胞中IL-6^＋γδ^＋ T细胞比例的影响比较（%，±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	9	2.10±0.24	3.48±0.41	3.25±0.50	4.34±0.27	5.40±0.28	5.47±0.28	7.23±0.42
HMBPP	9	2.97±0.41	4.45±0.34	3.61±0.31	9.86±0.45	17.98±0.62	27.25±0.43	34.49±0.88
E7	9	2.42±0.23	4.66±0.40	4.57±0.39	10.03±0.27	18.87±0.37	28.46±0.50	34.83±0.65
t值^a	?	1.85	1.84	0.61	10.51	17.90	41.95	28.33
P值^a	?	0.0826	0.0852	0.5534	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	0.98	2.08	2.09	14.90	26.79	39.97	35.73
P值^b	?	0.3409	0.0543	0.0534	<0.0001	<0.0001	<0.0001	<0.0001

表4 HMBPP或E7对脐带血分选出的共培养细胞中IL-6^＋γδ^＋ T细胞比例的影响比较（%，±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	9	2.10±0.24	3.48±0.41	3.25±0.50	4.34±0.27	5.40±0.28	5.47±0.28	7.23±0.42
HMBPP	9	2.97±0.41	4.45±0.34	3.61±0.31	9.86±0.45	17.98±0.62	27.25±0.43	34.49±0.88
E7	9	2.42±0.23	4.66±0.40	4.57±0.39	10.03±0.27	18.87±0.37	28.46±0.50	34.83±0.65
t值^a	?	1.85	1.84	0.61	10.51	17.90	41.95	28.33
P值^a	?	0.0826	0.0852	0.5534	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	0.98	2.08	2.09	14.90	26.79	39.97	35.73
P值^b	?	0.3409	0.0543	0.0534	<0.0001	<0.0001	<0.0001	<0.0001

表5 HMBPP或E7对结核性胸水分选出的共培养细胞中IL-6在mRNA水平表达情况的影响比较（±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	6	1.00	1.00	1.00	1.00	1.00	1.00	1.00
HMBPP	6	1.00±0.04	1.06±0.03	1.22±0.04	1.44±0.07	2.0±0.04	2.75±0.05	3.30±0.11
E7	6	1.02±0.05	1.02±0.04	1.24±0.05	1.39±0.09	2.00±0.07	2.83±0.06	3.60±0.09
t值^a	?	0.02	1.86	5.54	6.18	28.46	38.13	20.58
P值^a	?	0.9809	0.0931	0.0003	0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	0.47	0.55	4.65	4.42	14.04	29.43	28.88
P值^b	?	0.6513	0.5935	0.0009	0.0013	<0.0001	<0.0001	<0.0001

表5 HMBPP或E7对结核性胸水分选出的共培养细胞中IL-6在mRNA水平表达情况的影响比较（±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	6	1.00	1.00	1.00	1.00	1.00	1.00	1.00
HMBPP	6	1.00±0.04	1.06±0.03	1.22±0.04	1.44±0.07	2.0±0.04	2.75±0.05	3.30±0.11
E7	6	1.02±0.05	1.02±0.04	1.24±0.05	1.39±0.09	2.00±0.07	2.83±0.06	3.60±0.09
t值^a	?	0.02	1.86	5.54	6.18	28.46	38.13	20.58
P值^a	?	0.9809	0.0931	0.0003	0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	0.47	0.55	4.65	4.42	14.04	29.43	28.88
P值^b	?	0.6513	0.5935	0.0009	0.0013	<0.0001	<0.0001	<0.0001

表6 HMBPP或E7对脐带血分选出的共培养细胞中IL-6在mRNA水平表达情况的影响比较（±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	9	1.00	1.00	1.00	1.00	1.00	1.00	1.00
HMBPP	9	1.02±0.03	1.07±0.04	1.21±0.02	1.33±0.04	1.72±0.06	2.50±0.11	2.98±0.16
E7	9	1.04±0.03	1.06±0.03	1.25±0.02	1.29±0.04	1.58±0.06	2.52±0.14	3.19±0.11
t值^a	?	0.70	1.73	8.47	7.57	11.60	13.15	12.01
P值^a	?	0.4952	0.1034	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	1.12	1.80	11.42	6.83	9.78	10.94	20.51
P值^b	?	0.2785	0.0911	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001

表6 HMBPP或E7对脐带血分选出的共培养细胞中IL-6在mRNA水平表达情况的影响比较（±s）

组别	例数	30 min	5 h	12 h	24 h	36 h	48 h	72 h
对照组	9	1.00	1.00	1.00	1.00	1.00	1.00	1.00
HMBPP	9	1.02±0.03	1.07±0.04	1.21±0.02	1.33±0.04	1.72±0.06	2.50±0.11	2.98±0.16
E7	9	1.04±0.03	1.06±0.03	1.25±0.02	1.29±0.04	1.58±0.06	2.52±0.14	3.19±0.11
t值^a	?	0.70	1.73	8.47	7.57	11.60	13.15	12.01
P值^a	?	0.4952	0.1034	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	1.12	1.80	11.42	6.83	9.78	10.94	20.51
P值^b	?	0.2785	0.0911	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001

表7 HMBPP或E7对结核性胸水分选出的共培养细胞上清中IL-6分泌量的影响比较（pg/ml，±s）

组别	例数	5 h	12 h	24 h	36 h	48 h	72 h
对照组	11	3.75±0.34	7.86±0.31	22.28±0.94	25.65±0.97	28.48±0.58	32.66±0.91
HMBPP	11	4.78±0.40	16.99±0.86	34.71±0.87	48.78±1.23	49.07±1.24	64.37±2.04
E7	11	1.64±0.39	14.99±0.44	36.14±0.79	51.98±1.21	45.28±1.48	69.51±1.66
t值^a	?	1.95	10.01	9.73	14.73	15.07	14.21
P值^a	?	0.0653	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	1.735	13.36	11.26	16.92	10.56	19.43
P值^b	?	0.0981	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001

表7 HMBPP或E7对结核性胸水分选出的共培养细胞上清中IL-6分泌量的影响比较（pg/ml，±s）

组别	例数	5 h	12 h	24 h	36 h	48 h	72 h
对照组	11	3.75±0.34	7.86±0.31	22.28±0.94	25.65±0.97	28.48±0.58	32.66±0.91
HMBPP	11	4.78±0.40	16.99±0.86	34.71±0.87	48.78±1.23	49.07±1.24	64.37±2.04
E7	11	1.64±0.39	14.99±0.44	36.14±0.79	51.98±1.21	45.28±1.48	69.51±1.66
t值^a	?	1.95	10.01	9.73	14.73	15.07	14.21
P值^a	?	0.0653	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	1.735	13.36	11.26	16.92	10.56	19.43
P值^b	?	0.0981	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001

表8 HMBPP或E7对脐带血分选出的共培养细胞上清中IL-6分泌量的影响比较（pg/ml，±s）

组别	例数	5 h	12 h	24 h	36 h	48 h	72 h
对照组	17	3.05±0.20	15.39±0.47	18.68±0.72	23.55±0.90	28.65±0.96	30.13±0.75
HMBPP	17	3.66±0.24	20.07±0.66	43.84±1.32	5.029±0.58	60.29±0.83	63.37±0.70
E7	17	3.18±0.27	21.19±0.58	40.44±1.07	48.52±0.91	60.05±0.85	64.43±1.02
t值^a	?	1.90	5.78	16.73	24.93	24.93	32.47
P值^a	?	0.0659	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	0.39	7.78	16.93	19.46	24.51	27.16
P值^b	?	0.7024	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001

表8 HMBPP或E7对脐带血分选出的共培养细胞上清中IL-6分泌量的影响比较（pg/ml，±s）

组别	例数	5 h	12 h	24 h	36 h	48 h	72 h
对照组	17	3.05±0.20	15.39±0.47	18.68±0.72	23.55±0.90	28.65±0.96	30.13±0.75
HMBPP	17	3.66±0.24	20.07±0.66	43.84±1.32	5.029±0.58	60.29±0.83	63.37±0.70
E7	17	3.18±0.27	21.19±0.58	40.44±1.07	48.52±0.91	60.05±0.85	64.43±1.02
t值^a	?	1.90	5.78	16.73	24.93	24.93	32.47
P值^a	?	0.0659	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001
t值^b	?	0.39	7.78	16.93	19.46	24.51	27.16
P值^b	?	0.7024	<0.0001	<0.0001	<0.0001	<0.0001	<0.0001

表9 HMBPP或E7对脐带血分选出的共培养细胞中PD-L1在mRNA水平表达情况的影响比较及CD277^＋CD14^＋ PD-L1^＋细胞比例的影响比较（±s）

组别	例数	PD-L1在mRNA水平相对表达量	CD277^＋CD14^＋ PD-L1^＋细胞比例（%）
对照组	6	1.00	3.63±0.27
HMBPP刺激组	6	3.70±0.33	12.63±0.57
E7刺激组	6	4.20±0.34	15.11±0.65
t值^a	?	8.23	9.43
P值^a	?	<0.0001	<0.0001
t值^b	?	14.26	16.39
P值^b	?	<0.0001	<0.0001

表9 HMBPP或E7对脐带血分选出的共培养细胞中PD-L1在mRNA水平表达情况的影响比较及CD277^＋CD14^＋ PD-L1^＋细胞比例的影响比较（±s）

组别	例数	PD-L1在mRNA水平相对表达量	CD277^＋CD14^＋ PD-L1^＋细胞比例（%）
对照组	6	1.00	3.63±0.27
HMBPP刺激组	6	3.70±0.33	12.63±0.57
E7刺激组	6	4.20±0.34	15.11±0.65
t值^a	?	8.23	9.43
P值^a	?	<0.0001	<0.0001
t值^b	?	14.26	16.39
P值^b	?	<0.0001	<0.0001

表10 使用siRNA-PD-L1，HMBPP或E7对脐带血分选出的共培养细胞中PD-L1和IL-6在mRNA水平表达情况的影响比较（±s）

组别	例数	PD-L1	IL-6
空白对照组	5	0.96±0.02	0.96±0.03
阴性对照siRNA组	5	1.00	1.00
HMBPP＋PD-L1 siRNA转染组	5	0.44±0.04	0.53±0.03
E7＋PD-L1 siRNA转染组	5	0.52±0.04	0.55±0.01
t值^a	?	1.96	1.44
P值^a	?	0.0858	0.1893
t值^b	?	14.35	17.93
P值^b	?	<0.0001	<0.0001
t值^c	?	13.13	31.10
P值^c	?	<0.0001	<0.0001

表10 使用siRNA-PD-L1，HMBPP或E7对脐带血分选出的共培养细胞中PD-L1和IL-6在mRNA水平表达情况的影响比较（±s）

组别	例数	PD-L1	IL-6
空白对照组	5	0.96±0.02	0.96±0.03
阴性对照siRNA组	5	1.00	1.00
HMBPP＋PD-L1 siRNA转染组	5	0.44±0.04	0.53±0.03
E7＋PD-L1 siRNA转染组	5	0.52±0.04	0.55±0.01
t值^a	?	1.96	1.44
P值^a	?	0.0858	0.1893
t值^b	?	14.35	17.93
P值^b	?	<0.0001	<0.0001
t值^c	?	13.13	31.10
P值^c	?	<0.0001	<0.0001

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Effect of HMBPP and peptide E7 on IL-6 production by γδ T cells in pleural fluid of tuberculosis patients and umbilical cord blood

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Effect of HMBPP and peptide E7 on IL-6 production by γδ T cells in pleural fluid of tuberculosis patients and umbilical cord blood